Private Patients Policy

Transcription

1 Private Patients Policy KEY DETAILS: Description: Document Type: Document Keywords: Private Patient Policy POLICY Private patients Main areas affected: Care groups including specifically Consultants, private patients co-ordinators, admission officers and ward clerks and Cashiers. Date valid from: January 2010 Document review due date: December 2012 Final Validating Committee: Trust Executive Committee Author (title/position in SUHT) John Ward, Financial Controller, Sarah Wright, Project Accountant Accountable Officer/ Executive(s): Alastair Matthews (Director of Finance and Investment) Material suitable for publishing on: SUHTranet (Trust Staff Only): YES Is this a priority required for an external assessment or accreditation? Extranet (NHS Community): Internet (Public): NO AUDIT TRAIL: Date agreed: Version number: 1.0 (can be manually added when doc ument validated) Date archived: Date(s) Reviewed (if applicable): August 2011 Details of most recent review: Minor changes to reflect changed administrative responsibilities. Reference to Appendix D added NO NO Signature of Chairman of Validation Committee: Print Name: Dr Michael J. Marsh Post Held: Medical Director Date: Issued: Page 1 of 15 Version:

2 Contents: SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST 1. Purpose of this Policy / Procedure etc... 3 Summary... 3 Objectives/ success factors Scope of this Policy Links to other key Strategies & Policies Breach of this Policy and responsibilities of all staff Principles Standards to be followed On identification of a private patient On treating a Private patient Charges and Tariffs Changing the status of a patient Private Patient Requirements Communication and Education Plan for this Communication and Dissemination Plan Education and Support Plan Review plan for this Monitoring compliance and effectiveness Appendix 1 Guidance notes on the Policy... 8 Appendix A - Undertaking to pay form 9 Appendix B - Request to treat Private Patients within NHS facilities 10 Appendix C - Notification of Private Patients 11 Appendix D- Letter to patient 12 Consultation Process for this : Name of Committee/Group consulted None policy includes only minor changes from the previously agreed upon private patients policy. Name of Staff/Patient group consulted None as above. Date(s) Date(s) Equality Impact Assessment Does the guideline affect one group more or less favourably than another on the basis of any of the strands of diversity? NO Level of impact identified: (None/Low/Medium/High) None Full Assessment undertaken? NO All s must be accompanied by the completed Document Owner Checklist and the Equality Impact Assessment Tool. Issued: Page 2 of 15

3 1. Purpose of this Policy Private Patients Policy Summary This policy is issued by Southampton University Hospitals NHS Trust to provide guidelines on how to administer and account for patients undertaking to pay for hospital treatment. This policy is supported by the NHS Act 1977 for charging patients, and DoH guidelines A Code of Practice for Private Patients; Guidance for NHS Medical Staff. These s should be referred to where further clarification is required. Objectives/ success factors The objectives of this Policy are to ensure that: All private patients receiving treatment at the Trust are identified. Staff undertake work when it is permissible to undertake it and the terms under which treatment is provided. There is clarity on issues around charges and tariffs. There are provisions for changing the status of a patient from private to NHS. Private patients are able to pay for their treatment. There is guidance to Consultants, Private Patient Co-ordinators and admission officers / ward clerks on their roles in administering private patients. 2. Scope of this Policy This Policy includes: Guidance in line with each of the above objectives. 3. Links to other key Strategies & Policies See Private Patients Strategy dated May 2009 and the Private Patient Tariff published annually. 4. Breach of this Policy and responsibilities of all staff Consultants Full guidance can be found in the Department of Health A Code of Practice for Private Patients; Guidance for NHS Medical Staff. The treatment of private patients should not prejudice or interfere with, or be to the detriment of NHS patients. This includes any NHS on-call or emergency commitments that the Consultant is contracted to undertake. Consultants wishing to provide treatments to private patients within the Trust must seek the approval of the Trust Medical Director using the form in Appendix B. Failure to comply with Trust or NHS guidelines will lead to the withdrawal of any approval to treat private patients using Trust facilities. Issued: Page 3 of 15

4 Where Consultants wish to undertake private work this should be discussed with the Divisional Clinical Directors when preparing job plans to ensure that NHS commitments are fulfilled. Are prohibited from initiating any discussions in relation to providing private services for an NHS patient whilst working in an NHS capacity. Are required to disclose any outside business or professional interests that may give rise to an actual or perceived conflict of interest is they wish to treat private patients within the Trust. This should be undertaken at the start of each financial year using the form in Appendix B. Must inform the Private Patient Co-ordinator immediately of any planned admittance of a Private Patient. For any unplanned admission, the Consultant should work with the Private Patient Co-ordinator to identify the status of the patient. Unless otherwise stated, it is the Consultant s responsibility to bill for any medical fees for private patient work. The Trust may permit the utilisation of NHS facilities (e.g. secretarial resources) at their discretion to assist Consultants in their private practice. An administrative charge will be made for this. The Cashiers department will be responsible for providing a list of charges and their frequency. Private Patient Co-ordinators To ensure that the private patient is recorded on the admission schedules with their private status clearly indicated and that the details are passed to all relevant departments as well as the Cashiers office. To write to elective patients informing them of the estimated treatment costs and request insurance details or advance payment (See Appendix D). Where possible an Undertaking to Pay form (Appendix A) should be included with the letter. Agree an admission date with the patient and outline the plan for treatment. Questions of a medical nature must be referred to the Consultant. Prior to admission to liase with the patient s insurance company (if applicable) to agree admission and treatment details and to confirm the level of cover under the policy. Obtain a treatment authorisation number confirming the agreement to pay for treatment from the Insurance Company. This reference should be quoted in all correspondence to assist with prompt payment by the Insurance Company. For day cases and outpatients, to collate treatment information and costs and allocate by function. To provide information to allow for the cashiers office to raise invoices on completion of treatment and to code to the relevant functions involved. Liase with other Private Patient co-ordinators within the Trust to track private patients between specialties. Provide the following information to the Cashiers office Patients name; Patients hospital number; Private Patients reference number (from undertaking to pay form); Planned or actual treatment(s); Admission date; Discharge date. A sample form for this can be found in Appendix C. To check the weekly private patients report and notify the Cashiers office of any omissions. Where a patient is admitted outside of normal working hours the officer must determine whether the patient was admitted or transferred as a Private Patient (particularly if transferred from a private hospital or clinic). Issued: Page 4 of 15

5 To confirm the patient s treatment with the Consultant to verify the actual procedures undertaken. Admissions Officers / Ward Clerks To determine the status of the patient (private, overseas, NHS) and ensure that this is accurately recorded on the Patient Administration System. To inform the relevant Private Patient Co-ordinator of all patients who wish to be treated privately. Where a private patient is admitted outside of normal working hours send an to the Private Patient Co-ordinator notifying them of the admission. Finance (Cashiers) Collect and collate all in-patient costs including all diagnostics, support services, accommodation, theatre processes and administrative costs. An invoice should be raised for the total value and coded to each function. Record all Private Patients in a central register for the monitoring of treatments. From this, a weekly Private Patient Schedule should be produced for all patients and sent to Private Patient Co-ordinators and other key staff to check for any omissions of patients or costs. Raise invoices for all outpatient and daycases based on costing completed by the relevant departments or co-ordinators. Liase with Insurance Companies as appropriate. Verify that private patients have been correctly recorded on the Patient Administration System. Non-compliance with a Trust Policy, Procedure, PGD, protocol or patient information standard may result in disciplinary action. 5. Principles To ensure the effective and efficient operation of the treatment and administration of private patients within the Trust in line with the NHS Act 1977 for charging patients and DoH guidelines A Code of Practice for Private Patients; Guidance for NHS Medical Staff. 6. Standards to be followed 6.1 On identification of a private patient Private Patients should be identified prior to treatment. A General Practitioner or Trust Clinician may refer patients, or the patient may request to be treated privately upon admission. Private patients may be transferred from another private facility for medical reasons. These patients need to be identified as private patients to the private patient co-ordinators immediately. Admissions staff must check the status of each admission as NHS, Private or Overseas and ensure that this is accurately recorded on the patients record. Admissions of Private (and overseas) Patients must be notified to the Private Patients Co-ordinator. 6.2 On treating a Private patient Private patients may be treated within any of the Trusts facilities providing they, or their approved guarantor, have signed an Undertaking to Pay form, agreeing to pay Issued: Page 5 of 15

6 for their hospital treatment. This form must normally be completed prior to treatment, but may be signed retrospectively if circumstances prevent the patient from signing the form. The treatment of Private Patients must not interfere with the treatment of NHS patients. Any treatment must be based on clinical need, with NHS patients having priority where the need is equal. The Trust will charge Private Patients for accommodation but does not guarantee a particular level of accommodation. The charge may vary depending on facilities available, and will include nursing and other staffing costs, standard drugs, dressings, and capital expenditure. Complaints from Private Patients relating to treatment by Consultants, who are collecting private medical fees, should be directed to the Consultant themselves. All other complaints should follow the Trust Complaints Policy and Procedure. 6.3 Charges and Tariffs A patient may not be charged for any medical treatment that is received in A&E. An exemption from charges also applies to certain diseases where treatment is necessary to protect the wider public health (as defined in the Overseas Visitors Hospital Charging Regulations) Where a patient is transferred from a private hospital the status of the patient and the liability for any charges should be established at the earliest opportunity. The patient, and their insurance company, must be informed in advance of the estimated costs of treatment, including both Trust charges and Medical fees. The patient must be informed that they will be personally liable for all costs in excess of the insurance cover. All private patients must complete an Undertaking to Pay form (Appendix A), which is a legal contract. Forms are available from the Private Patient Co-ordinators and the Finance Directorate. Patients undertaking to pay for their treatment themselves must pay for the estimated cost of treatment in advance. The patient will be reimbursed where the actual costs are lower than the estimate or invoiced where the actual costs are higher. Where the patient is only partly covered by insurance the estimated excess must be paid in advance. A patient must not be admitted as a private patient unless payment has been received or adequate insurance cover has been confirmed. Medical fees, unless otherwise stated, are separate from any Trust fees. Trust fees will include, but are not limited to, accommodation, drugs (high cost, on discharge & outpatients), MSSE, any procedures performed, any specialist items used, any diagnostics performed and any support services such as physiotherapy. A mother and newborn baby are classed as one patient unless specifically requested otherwise, and a new Undertaking to Pay form completed. Contract negotiations with insurance companies should agree that an authorisation number be issued to the Trust for each patient s treatment, as an approval of treatment and undertaking to pay for treatment. Arrangements should be made for insurance companies to pay patients costs once they have received the Trust invoice and the medical expenses from the Consultant. All Trust charges for treatments should be taken from the Trusts Private Patient Tariff. A full range of procedures and tariffs are available from the Finance Directorate. The tariff will include current procedures, any exception charges, and any discounts permitted. The Finance Directorate will be responsible for updating the private patient tariff for Issued: Page 6 of 15

7 1 st April each financial year. Any patients whose treatment goes into a new financial year will be charged at the prices in the financial year of admittance. Any procedure not included in the tariff should be referred to the Finance Directorate for costing. 6.4 Changing the status of a patient A patient may not be treated as both an NHS and Private Patient for the same outpatient session, but may change their status at their next session. A Private in-patient has the right to change their status from private to NHS at any time during their course of treatment. They will remain liable for charges for the time they are a private patient. A change of status from private to NHS must be accompanied by an assessment of the patient s clinical priority for treatment and must be approved in writing by the Divisional Clinical Director. A copy of the approval must be sent to the Trust Private Patients Co-ordinator who will ensure that the change of status is properly recorded. Any patient who changes status must rejoin any NHS waiting list at the point they would have been prior to hospital admittance. 6.5 Private Patient Requirements A Private Patient must demonstrate their ability to pay for their treatment prior to admission. All Private Patients, or their approved guarantor, must complete an Undertaking to pay form prior to treatment and provide insurance details or prepay the estimated cost of treatment. Failure to produce insurance ation, or provide a prepayment will result in the cancellation of any treatments. Insurance details should be given to the Private Patient Officer who will contact the Insurance Company and inform them that treatment is due to commence, and confirm the patients insurance details and the level of cover. The officer will obtain an authorisation number from the company. The patient will be liable for any charges not covered by their insurance policy. Any patients paying for treatment, either in part or in full, themselves must make a payment in advance based on the estimated cost of treatment, this will include a 10% margin to cover any unforeseen treatments. 7. Communication and Education Plan for this 7.1 Communication and Dissemination Plan Policy to be sent to all DDO s, Lead Clinicians, Consultants, Private Patient Coordinators and Ward clerks as well as the Cashiers office once approved. 7.2 Education and Support Plan All new Consultants, Private Patient co-ordinators, ward clerks and members of the cashiers office to be provided with the policy when commencing employment at the Trust. 8. Review plan for this Monitoring compliance and effectiveness Guideline to be reviewed after 3 years or as any changes to practice occur END Issued: Page 7 of 15

8 9. Appendix 1 Guidance notes on the Policy Terminology Consultant Medical Fees Private Patient the clinician with responsibility for the patient, either the Trust clinician admitting the patient, or to whom the patient is assigned during their treatment. Any fees charged by a doctor for treatment or diagnostics provided to a Private Patient. any patient, or an agreed guarantor that has agreed to pay for their medical treatment. Although classed differently, some Overseas Patients will be covered by this policy (see the Overseas Patient policy for treatment of overseas patients). Private Patient Co-ordinators Private Patient Tariff The Trust designated roles within a division to co-ordinate the treatment of Private Patients. Each division must identify an individual with responsibility for Private Patients which may b a designated post or part of another one. the Trust s price guide for private medical treatment. Southampton University Hospitals NHS Trust Issued: Page 8 of 15

9 Appendix A PRIVATE PATIENT FORM Appendix B SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST Request to treat Private Patients with NHS facilities Request to regularly treat Private Patients within S.U.H.T UNDERTAKING TO PAY CHARGES IN RESPECT OF TREATMENT AS A PRIVATE PATIENT Name Name...Mr/Mrs/Miss/Other... of Staff: Forenames...Date of Birth... Address... Grade: Town...County...Postcode... Telephone Speciality: Numbers...(Home)...(Work) Next of Kin Disclosure Surname...Forename...Relationship... of external interests (To include Address... private clinics, hospitals and companies) Telephone Number... Company Name: Address: I...(Full Name) of...(address) undertake to pay all charges for hospital accommodation and services provided as a private resident patient for the above named to the Southampton University NHS Trust, irrespective of the outcome of the Treatment. I fully understand that if I am insured this does not mitigate my legal Company responsibility Name: to pay the account if for any reason my claim is rejected by my insurance Company. I further understand that such charges do not include the services of a medical or dental Address: practitioner under whom I/or... is being admitted and any other practitioner with whom I make arrangements for private treatment. I fully understand that the account will be referred to the Trusts Recovery Agents (CCI Legal Services Ltd) or other approved Debt Collection Agents in the event of non-payment and that all the above details will be made available to them. I have also made the next of kin named above Any other aware information that his/her details could be passed to a third party. This authority is unconditional and irrevocable. I fully understand that the Trust do not guarantee a particular level of accommodation. Signed...Name in Full...Date... Witness Name...Witness Signature...Date... FOR OFFICIAL USE ONLY Hospital...Ward...Date... I have Consultant...Date fully disclosed above all interests outside the of NHS Admittance...Date... that may provide potential conflicts of interest with my contractual obligations with the NHS. I have read the Trust Private Patient Policy and the Department of Health A code of Practice for Private Patients; Guidance for NHS Medical Staff Insurance Details Signature Name of Insurance Company... Approved Address... by:... Signature Registration/Claim No...Pre Authorisation Date No... Issued: Page 9 of 15 Date

10 Appendix B Request to treat Private Patients with NHS facilities Request to regularly treat Private Patients within S.U.H.T Name : Grade: Speciality: Disclosure of external interests (To include private clinics, hospitals and companies) Company Name: Address: Company Name: Address: Any other information I have fully disclosed above all interests outside the NHS that may provide potential conflicts of interest with my contractual obligations with the NHS. I have read the Trust Private Patient Policy and the Department of Health A code of Practice for Private Patients; Guidance for NHS Medical Staff Signature Date Approved by: Signature Date Name (Printed) Designation Issued: Page 10 of 15

11 Appendix C Notification of Private Patient Patients Name Patients Hospital No: Undertaking to Pay form number: Admission Date Discharge Date Treatments (planned or actual) Form submitted by: Name Designation: Extension Number: Directorate: Issued: Page 11 of 15

12 Appendix D Southampton University Hospital NHS Trust Tremona Road Southampton SO16 6YD Tel: (023) Date Name Address Address Address Postcode Dear Thank you for your enquiry regarding the cost of a procedure. The price for this is set out below and this includes the cost of the procedure and all the hospital costs. This does not include fees from any Consultant, which are billed separately. All procedures must be paid in full prior to admission and before receiving treatment. Payment can be made in the following ways. a. By Cash b. By travellers cheques c. Euros d. Debit/Credit cards (Switch, Delta, MasterCard & Visa) e. Cheques (we would need a cheque 7 days before admission) Cheques should be made payable to Southampton University Hospitals NHS Trust. Credit and Debit card payments can be made by telephone, via the Cashiers office (023) For any treatments using insurance cover, please contact with your insurance details in advance of your treatment. As treatment progresses it may become clear that the treatment will be more expensive than estimated, in this case you will be advised of the additional cost and the options available to you. If you decide to continue with the treatment you will again be asked to make an advance payment based on the estimated additional cost. If the actual cost of treatment is less than Issued: Page 12 of 15

13 estimated a refund will be made to you. You may ask for a statement of account at any time. You will be given a receipt for any monies paid. If you are insured we will require written confirmation in advance that you insurance company agrees to pay the additional charges. It is important that you understand the potential costs benefits, risks, burdens and side effects of any treatment before giving your consent to treatment. Please ask if you are in any doubt or if you need more time to make your decision. An Undertaking to Pay form is attached together with a copy of the Trust s terms and conditions which should be read in conjunction with this letter. Yours sincerely, Issued: Page 13 of 15

14 Terms & Conditions 1. General SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST 1.1. Please read these terms and conditions below carefully prior to agreeing to undertake treatment as they set out the terms upon which you will be provided with treatment and replace any previous terms and conditions which you may have received The charges for private patients are contained in the Trust Private Patient Tariff available on request or at The prices included within the tariff are in the main hospital charges for private patients and do not include the costs of Consultants and Consultant Anaesthetists who will agree charges and bill you directly unless specified otherwise All patients are required to sign an Undertaking to Pay agreement before an outpatient, day case or inpatient appointment or treatment can proceed. This applies to self paying and overseas patients as well as those with insurance and will cover any unforeseen costs No variations to the tariff will be made unless specifically agreed to in writing by the Trust authorised representative Patients should ensure that they understand which Universal Charges will be charged in addition to specified treatment costs prior to undergoing treatment as well as the expected costs for high cost consumables and drugs which will be charged The Trust is unable to accept responsibility for any personal property lost, stolen or damaged during a Hospital stay or visit and therefore advises that property brought into the Hospital is done so at the owner s risk No clinical treatment is without risk and therefore patients should ensure that they are fully aware of the risks and potential complications arising from treatments prior to undergoing treatments. 2. Insurance Companies 2.1. The prices listed in the tariff are those which will be billed to insurers by the Trust from 1 April to 31 March A referral of an insured patient to the Trust by the insurer constitutes acceptance of these terms and conditions Any signed agreement / contract made between the Trust and the insurer for the provision of Private Patient Treatment to their insured members, is made on the basis of this published tariff and any variation to prices contained therein, as agreed in writing In the absence of an alternative agreement in writing between the Trust and insurer made by 31 March, the prices contained within this tariff will always apply between 1 April and 31 March The insurer accepts the incorporation of this published tariff and any supporting price schedules referred to in the tariff (i.e. high value drugs costing over 25), into any standard contract for the provision of Private Patient Treatment services by the Trust. The tariff supersedes any listed procedure prices, treatments, procedures, drugs, consumables or other service inclusions or exclusions which may be included in the insurers standard contract. Issued: Page 14 of 15

15 2.6. Where full payment is not made and this has not been agreed in writing between the insurance company and the Trust the Trust reserves the right to collect the shortfall made against these tariff prices by an insurer from the insured patient. The Trust also reserves the right to charge a fee of 25 to the patient, to cover the cost of additional administrative services. 3. Insured Patients 3.1. The Trust is recognised by most UK insurers and charges will be recoverable under standard health insurance policies within the individual subscriber s agreement The medical insurance is a contract between the patient and the insurance company It is the responsibility of individual patients to obtain confirmation that any benefits will be sufficient to meet the anticipated cost of the treatment prior to hospital admission. Individuals must ensure that their insurance policy will meet the anticipated cost of the treatment to avoid delays as this confirmation will be required prior to the commencement of treatment If subsequent to treatment your insurance company does not recognise your claim then you will be personally responsible for payment. In addition should your insurance company refuse to pay a portion of your bill you will be responsible for payment along with any surcharges for additional costs incurred by the Trust Patients should also ensure that exclusions and waiting periods are adhered to prior to arranging for treatment to be undertaken, as defined in their policy (GP referral). 4. Self pay patients 4.1. Patients will also be charged additional amounts for sundry items such as telephone calls If you decide not to complete your treatment plan you will be charged in full up to the date of cancellation of treatment at the rates specified in the private patient tariff. If your consultant decides to amend or cancel your treatment you will be reimbursed for any amounts paid in advance at the rates specified in the private patient tariff All outpatients will be required to pay prior to the day of attending the appointment or on the day of the appointment prior to the appointment. Inpatient and day case patients will be required to pay a deposit equivalent to the estimated total cost of treatment 7 days prior to admission. All additional charges incurred above the estimated total cost of treatment must be paid prior to discharge Patients are required to inform the Cashiers Office of any changes to their contact details. 5. Cancellations 5.1. The Trust reserves the right to charge for cancellations as set out below: 6. Late Payments within 7 days of admission/ consultation 50% between 2 and 7 days of admission / consultation 75% on day of admission/ consultation 100% 6.1. The Trust reserves the right to charge interest at 5% above the Bank of England base rate for any overdue amounts. Issued: Page 15 of 15